Why chest pain is sometimes a muscle and joint problem and how to tell the difference
Nicola Tik
Chest pain is one of the symptoms that most reliably produces anxiety, and for good reason. The chest contains the heart and lungs, and pain in that area can feel alarming in a way that pain elsewhere in the body does not. What is less widely appreciated is that a significant proportion of chest pain, including pain that can feel quite pronounced, originates in the muscles, joints, and connective tissues of the chest wall rather than in the organs within it. Understanding the difference between the two, and recognising the characteristics that point towards an MSK origin, can reduce unnecessary anxiety while ensuring that symptoms that warrant attention are not dismissed.
The chest wall is a complex musculoskeletal structure in its own right. The ribcage consists of twelve pairs of ribs, each attached to the thoracic spine at the back and most of them connecting to the sternum at the front through cartilage. The joints where the ribs meet the sternum, and where they meet the thoracic vertebrae, are genuine synovial joints that can become irritated, inflamed, or restricted in the same way as joints elsewhere in the body.
The muscles between the ribs, the intercostal muscles, are involved in breathing and trunk movement and can develop the same kind of tension and sensitivity that affects muscles elsewhere under sustained demand. The pectoral muscles at the front of the chest, the serratus muscles along the sides, and the muscles of the upper back that attach to the ribcage all contribute to the chest wall's musculoskeletal picture and can all be sources of pain when they are overloaded or held under sustained tension.
The connection between desk work and MSK chest pain follows from the same postural patterns that affect the neck, shoulders, and mid back during a long sitting day.
Prolonged sitting in a rounded forward posture compresses the front of the chest and places the pectoral muscles and the cartilage joints at the front of the ribcage under sustained load. The joints where the ribs meet the sternum, when compressed and held in a fixed position for extended periods without the movement that keeps them mobile, can become stiff, irritated, and sensitive, producing a pain that is felt across the front of the chest and can be reproduced by pressing on the affected joint or by taking a deep breath.
This presentation is sometimes called costochondritis, an inflammation of the cartilage connecting the ribs to the sternum, and it is one of the most common MSK causes of chest pain. It tends to affect people who spend significant time in a forward-rounded posture, and it is frequently mistaken for cardiac pain because of its location. The distinguishing characteristic is that it is reproducible on pressure over the affected joint and tends to change with movement and breathing rather than being constant and unrelated to position.
Breathing patterns during desk work also contribute. Shallow, chest-based breathing that does not fully engage the diaphragm places the intercostal muscles and rib joints under a more restricted and less varied movement pattern than fuller breathing provides. Over time this restricted breathing movement can contribute to stiffness and sensitivity in the rib joints and intercostal muscles that is felt as chest discomfort, particularly when a deeper breath is taken or the trunk is rotated.
Sustained tension in the chest and upper body during concentrated or stressful desk work, the same pattern of unconscious muscular bracing that produces jaw and shoulder tension, can accumulate in the pectoral muscles and produce a feeling of tightness or pressure across the front of the chest that can feel unsettling when its muscular origin is not recognised.
Several daily habits outside of the desk environment contribute to MSK chest pain in ways that are worth being aware of.
Carrying heavy loads, particularly in a backpack or across one shoulder, places asymmetric load on the muscles and joints of the chest wall and upper back. During a period of MSK chest pain, distributing load more evenly and reducing the weight carried reduces this additional demand on already sensitised structures.
Sustained upper body effort, such as prolonged overhead work, heavy lifting, or any activity that requires sustained chest muscle engagement, can provoke or worsen MSK chest pain during a painful episode. Being mindful of these activities and building them up gradually rather than maintaining usual levels gives the affected structures more recovery opportunity.
Sleeping positions that compress the chest, particularly sleeping on the stomach or curling tightly onto one side, can increase the sensitivity of the rib joints and intercostal muscles overnight. Sleeping on the back or on the side with the chest in a more open position tends to produce less overnight provocation during a period of MSK chest pain.
Recognising the characteristics that suggest an MSK origin is particularly important for chest pain, because the distinction between MSK and non-MSK causes has more immediate clinical significance here than in most other areas.
MSK chest pain tends to be reproduced or worsened by specific movements, positions, or pressure. Pressing on the affected area, twisting the trunk, taking a deep breath, or moving the arm and shoulder on the affected side tends to change the intensity of the pain in a way that cardiac pain typically does not. The pain may be sharp or aching in quality, tends to be localised to a specific area of the chest wall rather than diffuse, and often has a clear relationship to posture and activity.
It is frequently worse after sustained sitting in a rounded position, after upper body effort, or during periods of stress, and tends to ease with gentle movement, warmth, and position change. It may be accompanied by tenderness at specific points along the sternum or ribcage that are identifiable on gentle pressure.
While MSK causes of chest pain are common, chest pain that does not fit the MSK pattern described above is worth getting assessed promptly rather than attributed to a musculoskeletal cause without professional evaluation.
Chest pain that is crushing, squeezing, or pressure-like in quality, that radiates into the arm, jaw, or back, that is accompanied by breathlessness, sweating, nausea, or a sense of something being seriously wrong, or that came on suddenly at rest without any relationship to movement or posture, is worth getting assessed urgently rather than managed at home.
Chest pain that is constant, unrelated to movement or pressure, and does not change with position or breathing is worth getting assessed even if it does not feel severe, because the absence of the positional and movement-related characteristics of MSK pain points towards a cause that warrants professional evaluation.
This is not a reason to assume the worst about every episode of chest pain. The majority of chest pain presenting in otherwise healthy people has a musculoskeletal or other benign cause. It is a reason to be appropriately attentive to the characteristics of the pain and to seek assessment when those characteristics do not clearly point towards an MSK origin.
A few practical adjustments tend to make a meaningful difference to MSK chest pain during and after a desk day.
Attending sitting posture, particularly avoiding the sustained forward-rounded position that compresses the front of the chest and loads the cartilage joints at the sternum, is the most directly relevant desk adjustment. Sitting back against a supported backrest, allowing the chest to open rather than compress, and keeping the screen at a height that does not encourage the head and shoulders to round forward all reduce the sustained load on the chest wall structures.
Fuller breathing that engages the diaphragm and allows the ribcage to expand naturally reintroduces the movement in the rib joints and intercostal muscles that shallow breathing suppresses. Taking a few deliberate fuller breaths several times through the day, allowing the chest to expand with each inhale, gently mobilises the affected joints in a way that sustained shallow breathing does not.
Warmth applied to the affected area, whether a heat pack across the chest or a warm shower, can ease the muscular tension and joint sensitivity that MSK chest pain involves, particularly after a long desk session.
Gentle trunk rotation and chest opening movements during regular breaks from sitting help counteract the sustained forward compression of the desk position and maintain the mobility of the rib joints and surrounding muscles.
Your VIDA programme includes upper back and thoracic mobility exercises that address the postural patterns contributing to MSK chest pain and support the gradual recovery of the affected structures.